ABSTRACT
ABSTRACT Background: Chagas disease is gaining importance in the Brazilian Amazon region as a differential diagnosis of febrile syndrome. The most recent microoutbreak occurred in Ipixuna, in Amazonas state. Methods: An epidemiological survey was conducted using parasitological and serological tests, and electrocardiographic analysis. Results: The patients belonged to one family and had ingested açaí acquired from Ipixuna. All patients reported fever and initially a thick blood smear test was done to identify Trypanosoma cruzi. Benznidazole treatment was administered to all patients. Conclusions: Knowledge of the epidemiological dynamics of Chagas disease allows us to improve control and management measures for this disease.
ABSTRACT
Abstract Chagas disease (CD), with approximately 10,000 deaths annually, has become a worldwide health problem. Approximately 35% of cases may show cardiac manifestations such as arrhythmias and/or conduction disorders, heart failure, thromboembolic accidents, and sudden death. The Amazon region has long been considered a non-endemic area for CD; however, in the last decades, with an increase in the number of acute and chronic cases, disease evolution has received greater attention. Here, we report the successful implementation of a cardioverter-defibrillator for the prevention of sudden death in a patient with autochthonous Chagas cardiomyopathy in the Brazilian Amazon.
Subject(s)
Humans , Chagas Cardiomyopathy/complications , Defibrillators, Implantable , Brazil , Death, Sudden, Cardiac/prevention & control , ElectrocardiographyABSTRACT
A expressão "segurança do paciente" refere-se à redução a um nível mínimo aceitável do risco de dano desnecessário associado ao cuidado em saúde. Estudos internacionais indicam uma ocorrência de dois a três incidentes de segurança do paciente por 100 consultas na APS, com frequência similar no Brasil. Realizamos um estudo descritivo para identificar incidentes de segurança do paciente na APS de Manaus, AM, Brasil, em 2018, mediante notificações voluntárias de médicos selecionados por amostragem por conveniência. As 105 notificações coletadas permitiram calcular uma incidência de três incidentes de segurança por 1.000 atendimentos no trimestre estudado. Em 82% dos incidentes, houve envolvimento do usuário. Em 39 notificações (37%), houve registro de dano, sendo 33% de dano mínimo, 17% de dano moderado e dois óbitos. Os resultados implicam no incentivo a ações de educação em saúde sobre o tema voltadas aos usuários.(AU)
Patient safety means reducing the risk of unnecessary healthcare-associated damage to a minimum acceptable level. International studies show an occurrence of 2-3 patient safety incidents per 100 primary healthcare appointments, with similar frequency in Brazil. We conducted a descriptive study to identify patient safety incidents in Primary Healthcare in the Brazilian city of Manaus, state of Amazonas, in 2018, by voluntary notification of doctors selected by convenience sampling. The 105 collected notifications enabled to calculate an incidence of 3 safety incidents per 1,000 appointments in the studied quarter. In 82% of the incidents, the user was involved. In 39 notifications (37%), the damage was recorded—33% of them were minimum, 17% moderate, and 2 deaths. The results imply an incentive to actions of health education on user-related topics.(AU)
La seguridad del paciente es la reducción a un nivel mínimo aceptable de riesgo de daño innecesario asociado al cuidado de salud. Estudios internacionales indican una ocurrencia de dos a tres incidentes de seguridad del paciente por 100 consultas en la Atención Primaria de la Salud (APS), con frecuencia similar en Brasil. Realizamos un estudio descriptivo para identificar incidentes de seguridad del paciente en la APS de Manaus, Estado de Amazonas, en 2018, mediante notificaciones voluntarias de médicos seleccionados por muestreo por conveniencia. Las 105 notificaciones colectadas permitieron calcular una incidencia de tres incidentes de seguridad por 1000 atenciones en el trimestre estudiado. En el 82% de los incidentes hubo envolvimiento del usuario. En 39 notificaciones (37%) hubo registro de daño, siendo el 33% de daño mínimo, el 17% de daño moderado y dos fallecimientos. Los resultados implican en el incentivo a acciones de educación en salud sobre la cuestión, enfocadas en los usuarios.(AU)
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Aged , Young Adult , Primary Health Care/ethics , Health Centers , Patient Safety/statistics & numerical data , Mandatory ReportingABSTRACT
Abstract Background: In the past two decades, a new epidemiological profile of Chagas' disease (CD) has been registered in the Brazilian Amazon where oral transmission has been indicated as responsible for the increase of acute cases. In the Amazonas state, five outbreaks of acute CD have been registered since 2004. The cardiac manifestations in these cases may be characterized by diffuse myocarditis, with alteration in the electrocardiogram (ECG) and transthoracic echocardiogram (TTE). Objective: To perform a cardiac evaluation in autochthonous patients in the acute phase and at least one year after submitted to treatment for acute CD and evaluate the demographic variables associated with the presence of cardiac alterations. Methods: We evaluated patients diagnosed with acute CD through direct parasitological or serological (IgM) methods from 2007 to 2015. These patients were treated with benznidazole and underwent ECG and TTE before and after treatment. We assumed a confidence interval of 95% (CI 95%, p < 0.05) for all variables analyzed. Results: We observed 63 cases of an acute CD in which oral transmission corresponded to 75%. Cardiac alterations were found in 33% of the cases, with a greater frequency of ventricular repolarization alteration (13%), followed by pericardial effusion (10%) and right bundle branch block and left anterior fascicular block (2%). The follow-up occurred in 48 patients with ECG and 25 with TTE for a mean period of 15.5 ± 4.1 months after treatment. Of these, 8% presented normalization of the cardiac alterations in ECG, 62.5% remained with the normal exams. All of the patients presented normal results in TTE in the post-treatment period. As for the demographic variables, isolated cases presented more cardiac alterations than outbreaks (p = 0.044) as well as cases from Central Amazonas mesoregion (p = 0.020). Conclusions: Although cardiac alterations have not been frequent in most of the studied population, a continuous evaluation of the clinical-epidemiological dynamics of the disease in the region is necessary in order to establish preventive measures.
Resumo Fundamento: Nas últimas duas décadas, um novo perfil epidemiológico da Doença de Chagas (DC) foi registrado na Amazônia brasileira, onde a transmissão oral foi indicada como responsável pelo aumento dos casos agudos. No estado do Amazonas, foram registrados cinco surtos da doença desde 2004. As manifestações cardíacas nesses casos podem ser caracterizadas por miocardite difusa, com alteração nos resultados eletrocardiograma (ECG) e ecocardiografia transtorácica (ETT). Objetivo: avaliar parâmetros cardíacos em pacientes autóctones com DC na fase aguda e em um ano ou mais após tratamento, e avaliar as variáveis demográficas associadas com a presença de alterações cardíacas. Métodos: Avaliamos os pacientes diagnosticados com DC aguda por método direto parasitológico e exame sorológico (IgM) entre 2007 e 2015. Os pacientes foram tratados com benzonidazol e submetidos à ECG e ETT antes e após tratamento. Assumimos um intervalo de confiança de 95% (p < 0,05) para todas as variáveis analisadas. Resultados: Observamos 63 casos de DC aguda em que a transmissão oral ocorreu em 75% dos casos. Alterações cardíacas foram encontradas em 33% dos casos, com maior frequência de repolarização ventricular (13%), seguida de derrame pericárdico (10%), e bloqueio do ramo direito e bloqueio fascicular anterior esquerdo (2%). O acompanhamento foi realizado com 48 pacientes com ECG e 25 com ETT por um período médio de 15,5±4,1 meses após o tratamento. Desses pacientes, observou-se normalização das alterações eletrocardiográficas em 8% dos pacientes, e 62,5% continuaram com os parâmetros normais. Todos os pacientes apresentaram resultados da ETT normais no período pós-tratamento. Quanto às variáveis demográficas, os casos isolados apresentaram mais alterações cardíacas em comparação aos casos de surtos (p=0,044) e os casos identificados na mesorregião do Amazonas Central (p = 0,020). Conclusões: Apesar de as alterações cardíacas não terem sido frequentes na maioria da população do estudo, é necessária uma avaliação contínua da dinâmica clínica-epidemiológica da doença na região para se estabelecer medidas preventivas.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , Trypanocidal Agents/therapeutic use , Chagas Cardiomyopathy/parasitology , Chagas Disease/drug therapy , Nitroimidazoles/therapeutic use , Trypanosoma cruzi/isolation & purification , Brazil/epidemiology , Echocardiography , Chagas Cardiomyopathy/diagnostic imaging , Follow-Up Studies , Chagas Disease/complications , Chagas Disease/epidemiology , ElectrocardiographyABSTRACT
Abstract We describe the recurrence of cardiac abnormalities in a patient treated during the acute phase of Chagas disease after outpatient follow-up of 5 years.
Resumo Descreve-se a recorrência de alterações cardíacas em paciente tratado na fase aguda de doença de Chagas, após seguimento ambulatorial de 5 anos.
Subject(s)
Humans , Male , Adolescent , Arrhythmias, Cardiac/etiology , Chagas Cardiomyopathy/drug therapy , Chagas Disease/drug therapy , Arrhythmias, Cardiac/drug therapy , Recurrence , Trypanocidal Agents/therapeutic use , Acute Disease , Electrocardiography , Nitroimidazoles/therapeutic useABSTRACT
Chagas disease (CD) is a parasitic infection that originated in the Americas and is caused by Trypanosoma cruzi. In the last few years, the disease has spread to countries in North America, Asia and Europe due to the migration of Latin Americans. In the Brazilian Amazon, CD has an endemic transmission, especially in the Rio Negro region, where an occupational hazard was described for piaçaveiros (piassaba gatherers). In the State of Amazonas, the first chagasic infection was reported in 1977, and the first acute CD case was recorded in 1980. After initiatives to integrate acute CD diagnostics with the malaria laboratories network, reports of acute CD cases have increased. Most of these cases are associated with oral transmission by the consumption of contaminated food. Chronic cases have also been diagnosed, mostly in the indeterminate form. These cases were detected by serological surveys in cardiologic outpatient clinics and during blood donor screening. Considering that the control mechanisms adopted in Brazil's classic transmission areas are not fully applicable in the Amazon, it is important to understand the disease behavior in this region, both in the acute and chronic cases. Therefore, the pursuit of control measures for the Amazon region should be a priority given that CD represents a challenge to preserving the way of life of the Amazon's inhabitants.
Subject(s)
Animals , Digestion/genetics , Horses/genetics , Pancreatic alpha-Amylases/genetics , Salivary alpha-Amylases/genetics , Amino Acid Substitution , Base Sequence , Biodiversity , Edible Grain/chemistry , Dietary Carbohydrates , Genetic Variation , Genotyping Techniques , Horses/classification , Italy , Polymorphism, Single Nucleotide , Sequence Alignment , Sequence Analysis, DNAABSTRACT
Este estudo avaliou a frequência de cardiopatia chagásica crônica (CCC) em 37 pacientes autóctones da Amazônia com disfunção sistólica ventricular esquerda sem etiologia definida. Foram diagnosticados três casos com frequência de 8,1 por cento no grupo estudado.
This study assessed the frequency of chronic chagasic cardiopathy (CCC) in 37 autochthonus patients from Amazon region with left ventricular systolic dysfunction of undefined etiology. Three cases were diagnosed in the studied sample, with an 8.1 percent frequency.
Este estudio evaluó la frecuencia de cardiopatía chagásica crónica (CCC) en 37 pacientes autóctonos de la Amazonía con disfunción sistólica ventricular izquierda sin etiología definida. Se diagnosticaron tres casos con frecuencia del 8,1 por ciento en el grupo estudiado.